By Françoise Mathieu, M.Ed., CCC.

Part One: Beyond Kale and Pedicures


I have been locked out of the seminar room.

Peering through the glazing, I can see two dozen Operating Room nurses in scrubs, milling about inside the auditorium. The space is nearly full, and they are chatting and eating lunch. The session on compassion fatigue and self-care is about to begin, but the door is locked and I can’t get in. I knock once, and then again a little bit louder. They can see me, but no one comes to unlock the door.

Problem is, I am the presenter, and this isn’t starting out particularly well.

After a few minutes, the caterer, who has just delivered sandwiches to the team, unlocks the door from the inside and whispers to me on his way out: “I’m warning you, it’s worse than high school in there.” It turns out that this group has just learned that all of their summer leave has been cancelled, due to cutbacks, but this session is mandatory, so there they are, steaming mad, and not particularly inspired to discuss sleep hygiene and breathing with me.

Luckily, this isn’t my first rodeo, so I am not too rattled. I am also lucky to rarely encounter such hostile audiences, but I do specialize in delivering training to high stress, high trauma-exposed helping professionals: prison guards, child welfare workers, trauma nurses and docs, and so many others who are trying to care for patients and clients in an increasingly challenging and under-resourced climate. But at this point, in 2011, I am starting to ask myself whether what I am teaching them is at all effective.

Many of my audiences express growing frustration at working in a system that feels broken, and no amount of kale and yoga can fix that overnight.

I became a compassion fatigue specialist by accident, or rather, by necessity. I completed my counselling degree nearly 20 years ago and I was very fortunate in receiving first-rate training at Columbia University and at the University of Toronto. Our courses explored issues of multiculturalism, racism, gender bias, addiction, transference, and many other challenging and stimulating topics.

The Columbia program was considered pretty cutting edge, and by virtue of its location and affiliations we had the opportunity to hear from guest lecturers who were truly thought leaders in the field. Once, our class attended a clinical demonstration with the renowned psychologist Dr. Albert Ellis. I didn’t particularly like it – or him, for that matter, but these were invaluable opportunities to learn from the big guns. Our training invited rigorous self-reflection and an exploration of our own biases and assumptions.

However, in spite of all this excellent training, I never once heard any of my instructors mention the concepts of burnout, compassion fatigue (CF), vicarious trauma (VT), secondary traumatic stress (STS) or even use the words “self-care” in any of their lectures. I also received no training in psychological trauma, except for a brief mention in one lecture. After graduation, I soon discovered that in spite of the great pedigree of my alma maters, I was completely ill equipped for the real world of mental health counseling.

Crisis work is what drew me to the field. Before pursuing graduate training I had worked as a volunteer in a hospital emergency ward. We saw it all – multiple vehicle accidents, entire families wiped out by a drunk driver, children who had been harmed by their parents, heart attacks, overdoses. It was intense, sometimes shocking work and I absolutely loved it. Have you ever had this feeling that something is just a perfect fit? You just know?  That’s how I felt about crisis intervention. This was it, the career that had been waiting for me. I am sure that my attraction to crisis work was partly due to my own life history, having been the informal crisis counselor to members of my extended family during my teens, during a dark and tumultuous decade of traumas that befell us. This is not unusual – therapists are often drawn to the field for personal reasons, whether they fully recognize it or not.

Frankly, part of what I loved about crisis work was the adrenaline rush – the speed and intensity of the work, being able to rapidly triage clients and provide immediate relief – the crisis counselor is the port in the storm. Over my career as a crisis and trauma therapist, I worked with people from every walk of life: soldiers returning from Afghanistan and Rwanda, police officers, prison guards, physicians, suicidal students and many other individuals in distress. With little relevant training and minimal supervision, I pretty much flew by the seat of my pants during the first few years until I attended some outstanding trauma workshops that gave me the tools I sorely needed.

Over time, even though I loved the work, the stories began to haunt me, and they would sometimes interfere with my ability to relate to my friends and family. How does one go from hearing a soldier talk about a beach full of bloated corpses in the Rwandan genocide to helping a spouse pick a new couch?  I also found that I was attracted to high trauma material in my personal life – reading books by incest survivors, watching movies about death, poverty and loss, volunteering at the local maximum security prison. I was living, breathing and sleeping other people’s trauma, without a moment’s thought about how this was impacting me or my loved ones.

Meanwhile, the volume of work continued to grow. I was employed in a very busy counseling center for several years and the waiting lists were completely unmanageable. How do you tell a rape survivor that you can’t see them for another 5 weeks because your schedule is completely jammed? Although the secondary exposure to trauma impacted me profoundly, I was far more upset about my working conditions and unmanageable workload, which were a perfect recipe for burnout, and I was much more distressed, morally, about turning clients away than I was about their trauma stories.

Finally, after several years of working in mental health, I felt stuck in an unresolvable dilemma: I loved trauma work and yet trauma work was damaging me. Was there a way to stay in this field while remaining healthy and grounded?  I wasn’t sure. Self-care was not a topic on anyone’s lips in my circle of colleagues.

Then, one day, in 2001, a coworker drew my attention to a newly released book on something called “vicarious trauma”, and that was a light bulb moment for me. I started reading everything I could get my hands on about burnout, compassion fatigue, and secondary trauma. Over time, I gained a solid understanding of the problem and incidence rates, but the literature was fairly slim on ways to resolve the issue. What worked to reduce or even prevent the problem? Other than a self-care checklist, and recommendations to exercise and eat healthily, there didn’t seem to be much else on offer at the time. Seeing a training gap and a pressing need among helping professionals, a close colleague and I designed a compassion fatigue workshop and began offering it across the country. It wasn’t hard to make the case for the problem – there was plenty of data to support our message  – but we had to look long and hard for evidence-based research on solutions to compassion fatigue and secondary trauma. So, we worked with what we had, and we focused our workshops on individual self-care. We did not realize at the time that we were part of an emerging trend.

In fact, since the 1990s, when research on compassion fatigue and secondary trauma initially started, there has been an emergence of an entirely new industry of helper wellness: workshops, books, retreats and videos, all aiming to “help the helper”. Armed with new data, many human service organizations jumped on the bandwagon and focused almost exclusively on self-help strategies to support their staff. HR departments began running workshops for staff on healthy eating, work-life balance and “stress busting”. Some organizations implemented regular fitness breaks and staff appreciation days. This single-minded focus on self-care and wellness is not entirely surprising: North America is an enthusiastic self-help culture – we embrace the latest books on weight loss and decluttering with gusto and we celebrate Dr. Oz and Oprah as they recommend the next new cure to life’s travails.

The problem is that these initiatives didn’t really work – many staff stayed away from the wellness sessions, rates of burnout did not decrease significantly and staff morale continued its downward spiral. To be fair, it made sense for workplaces to focus on helper self-care: it was inexpensive, easily implemented and it didn’t require major systemic change – it was something concrete that they could do. But maybe, in our enthusiasm to find solutions to CF and STS, we all jumped the gun a little bit.

Tomorrow: Part Two – Does Self Care Work?

Françoise Mathieu is a mental health professional and a compassion fatigue specialist. She is the author of The Compassion Fatigue Workbook (2012) and co-author with Leslie McLean of a book chapter entitled: Managing Compassion Fatigue, Moral Distress and Burnout in a context of patient-centered care in Walton, M., Barnsteiner, J., & Disch, J. (eds) Patient/Family Centered Care – Patient and Care Provider Considerations, Sigma Theta Tau International, 2014. She is also the author of several magazine articles.

Françoise is chair of the annual CARE4YOU Conference on Compassion Fatigue


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